The Institute for Health Indicators and Assessment estimates that only 7% of positive Covid-19 cases in the United States are detected, which means that the percentage of cases is actually 14.5 times higher than officially reported. The last time the infection rate was so low was at the beginning of the pandemic, in March 2020.
As the use of Covid-19 tests at home increases, there is a growing fear that most of these test results remain unaccounted for, leading to an underestimation of the true number of Covid-19 cases across the country.
Another reason the detection rate is so low, Moqdad said, is that the majority of people infected with the Omicron coronavirus variant show no symptoms, so they don’t even know how to get tested.
Why tests are important
Many diseases have a low detection rate, Moqdad said, like the flu.
“The difference is that this is a pandemic,” he said.
When people hear that there are many cases of Covid-19 in their area, some may become more cautious. This can prevent them from getting sick and not spreading the virus.
Testing can also tell public health experts what measures to put in place to keep people safe. For example, when the number of cases in Philadelphia increased recently, it returned a mandate for an indoor mask.
“We should always get ahead of this, not just hope it’s gone,” said Mara Aspinal, a testing expert and professor of practice at the College of Health Solutions at Arizona State University.
Testing is also important at the individual level. He tells people if they need to isolate themselves so that other people don’t get sick. He also tells them if they should seek treatment for Covid-19, which works best when the disease is caught early.
Changing the model
Pennsylvania, Ohio and New York state health departments say the positivity rate is no longer a reliable indicator. Nevada has completely removed the number of cases from its data dashboard.
Government officials acknowledge that the ubiquity of home tests has led to under-reporting of cases, especially mild to moderate disease, and say it is difficult to quantify the impact of these missing data.
But the New Jersey Department of Health says the unreliability of case data probably doesn’t hamper its ability to characterize the severity of the pandemic. There are other indicators that can give an idea of how much disease there is in the community.
The US Centers for Disease Control and Prevention has updated its own indicators to determine what restrictions on Covid-19 may be needed. Instead of relying on the number of cases, hospitalizations are weighed more heavily. The agency also monitors other indicators, such as the levels of the virus found in wastewater.
Cases are a good indicator of jumps, but they are not everything, said Spencer Fox of the Covid-19 Modeling Consortium at the University of Texas. His model is based on hospital admissions tested for antibody levels in blood samples.
Fox says this is the “gold standard” for assessment in the beginning, but “it’s getting more complicated because the landscape of immunity in the country is changing.”
Omicron is highly transmitted and reinfections are becoming more common.
In general, however, he believes that the understanding of pandemic data is not necessarily worse than it was before – “but things may change.”
Efforts to streamline the delivery of test results at home
States like Tennessee encourage people who use tests at home to present their results to manufacturers so they can be tracked. It is not clear how many people actually do this, but several efforts are being made to better track home tests.
The Association of Public Health Laboratories is working with the NIH on a contract to use the association’s electronic laboratory reporting platform, AIMS, to help streamline the reporting of Covid-19 home test results.
This approach still relies on people using home tests to report their results to manufacturers, but Scott Becker, CEO of the Association of Public Health Laboratories, hopes the AIMS system will facilitate the process of reporting manufacturers to public authorities. healthcare.
The initiative “is a recognition of the fact that there is this gap in reporting,” Becker said.
“From a public health perspective, it’s kind of like a missing data point, if you will, in the testing universe,” Becker said of the test results at home. “It’s kind of a blind spot.”
The Public Health Laboratories Association announced in March that it had received a $ 8.8 million contract with the NIH to work to improve the reporting of Covid-19 over-the-counter test results at employees’ homes. public health. The agreement uses AIMS to collect data from home test manufacturers and then disseminate the data to countries and jurisdictions.
“The home test has a digital tool that goes with it, and we’re trying to build a substantive specification that allows data to go through the center to where it should be obtained to report the condition,” Becker said. “There are countries that are interested in getting this data and it is really about awareness of the situation.
Another platform that calls for greater efficiency is ReportStream, a cloud-based data routing system created by the US Digital Service in partnership with the US Centers for Disease Control and Prevention. The US Food and Drug Administration requires manufacturers of Covid-19 home tests to develop a mobile phone application or website “to further facilitate the reporting of facial results” using the home test.
“The FDA asked for post-marketing digital solutions to be reported, but other than that, the guidelines were limited and that meant when digital solutions were being built and these tests were reported, the way the reporting was done was inconsistent in different formats. just make data collection bad. This has made data analysis very difficult, “said Dr. Krishna Juluru, Presidential Innovation Officer at the National Institute of Biomedical Imaging and Bioengineering, who advises digital health solutions for the RADx initiative.
Juluru and his colleagues worked on “setting standards and common avenues for communicating these results.”
Platforms such as AIMS and ReportStream, called hubs, serve as destinations where Covid-19 test results at home can be sent and then passed on to public health services that request the data. An additional de-identified copy of the message is sent to a federal system called HHS Protect, creating a unified national view of Covid-19 test results.
At the state level, AIMS connects to all states and territories in the United States and has long been used to direct laboratory test results to government health systems, according to the NIH, and ReportStream connects to most states.
“So this takes that burden off the test maker, the application developer, the need to develop direct links with all states,” said Andrew Weiss, program director at the National Institute of Biomedical Imaging and Bioengineering and co-chair of RADx. Mobile Application Reporting through the Standards program, or RADx MARS, with Juluru.
Every laboratory-based Covid-19 testing site is required to report the results of diagnostic and screening tests to state or local public health authorities, but those who perform self-tests are not required to report the results. This can lead to failure to report many home test results, leading to data gaps.
“Although it is still up to people to decide to report, we still hope to tackle this blind spot,” Juluru said.
“We need to be more strategic”
There are estimates of how many tests at home may go unreported.
A pre-release study by researchers at the University of Massachusetts and other US institutions published this month suggests that when people use Covid-19 tests at home, only about 8.1% will also use the “digital assistant” or app. that comes with it.
However, more than 75% of those who have used the app have reported their results to public health authorities. People are less likely to report if they test positive.
“Voluntary reporting was generally low, but what we also found was that when people used a digital solution – when they actually had access to their digital instrument to help them run their test, to give them instructions. how to do it – we found that the reporting rate is very high, on the order of more than 75%, “said Juluru.” It’s actually very encouraging. “
Overall, the low use of the app may be due to a lack of education about the importance of reporting test results, the researchers said.
When it comes to Covid-19, the number of cases reported in each state will continue to decline and continue, and it will be important to track these data and monitor the spread of the disease, Becker said.
Jennifer Nuzo, an epidemiologist and professor at Brown University, believes more needs to be done to monitor the pandemic to make up for the lack of data.
“We will see a signal. It will simply be more difficult to interpret and know what to do about it, “said Nutzo, who is director of the Brown Pandemic Preparedness and Response Center in Brown.
Population-based surveys would help.
“We need to be more strategic. You just can’t do more home tests,” Nuzzo said. “If you go out and deliberately try in these neighborhoods, we will have a better understanding.”
Nutso’s main concern is that the country is now at a disadvantage in understanding how the virus is transmitted. “If people get sick in the grocery store, then you need to know this to encourage people to wear masks. If it’s 5 years old, you can take action there, “she said.
“We have so many more tools and we don’t use them in a strategic and meaningful way.”
Becker said anyone with symptoms of Covid-19 – even a single snoring – should be tested.
“People have this ability to test themselves with a really good degree of confidence,” he said. The best approach is, if you are testing and you are positive, then reach out to the clinical environment, to your …
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